Provider Demographics
NPI:1487324885
Name:THOMPSON, SHATIA SHARIE (LBS)
Entity type:Individual
Prefix:MRS
First Name:SHATIA
Middle Name:SHARIE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 DARBY RD APT C63
Mailing Address - Street 2:
Mailing Address - City:PROSPECT PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19076-2509
Mailing Address - Country:US
Mailing Address - Phone:516-476-5987
Mailing Address - Fax:
Practice Address - Street 1:1086 HIGHWAY 315 BLVD
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-7012
Practice Address - Country:US
Practice Address - Phone:570-846-1025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH005523103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst